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CMS Recommends Postponing Elective Cases

By March 19, 2020No Comments

******The Following Content Was Published By The Centers for Medicare and Medicare Services*****

CMS Releases Recommendations on Adult Elective Surgeries, Non-Essential Medical, Surgical, and Dental Procedures During COVID-19 Response:

At the White House Task Force Press Briefing on March 18, the Centers for Medicare & Medicaid Services (CMS) announced that all elective surgeries, non-essential medical, surgical, and dental procedures be delayed during the 2019 Novel Coronavirus (COVID-19) outbreak.

As more healthcare providers are increasingly being asked to assist with the COVID-19 response, it is critical that they consider whether non-essential surgeries and procedures can be delayed so they can preserve personal protective equipment (PPE), beds, and ventilators.

“The reality is clear and the stakes are high: we need to preserve personal protective equipment for those on the front lines of this fight,” said CMS Administrator Seema Verma.

This will not only preserve equipment but also free up our healthcare workforce to care for the patients who are most in need. Additionally, as states and the nation as a whole work towards limiting the spread of COVID-19, healthcare providers should encourage patients to remain home, unless there is an emergency, to protect others while also limiting their exposure to the virus. They should also urge patients to follow the President’s recently issued guidelines to help slow the spread of the virus.

The recommendations provide a framework for hospitals and clinicians to implement immediately during the COVID-19 response. The recommendations outline factors that should be considered for postponing elective surgeries, and non-essential medical, surgical, and dental procedures. Those factors include patient risk factors, availability of beds, staff and PPE, and the urgency of the procedure. This will help providers to focus on addressing more urgent cases and preserve resources needed for the COVID-19 response. The decision about proceeding with non-essential surgeries and procedures will be made at the local level by the clinician, patient, hospital, and state and local health departments.

CMS Adult Elective Surgery and Procedures Recommendations:
Limit all non-essential planned surgeries and procedures, including dental, until further notice

To aggressively address COVID-19, CMS recognizes that conservation of critical resources such as ventilators and Personal Protective Equipment (PPE) is essential, as well as limiting exposure of patients and staff to the SARS-CoV-2 virus. Attached is guidance to limit non-essential adult elective surgery and medical and surgical procedures, including all dental procedures. These considerations will assist in the management of vital healthcare resources during this public health emergency.

Dental procedures use PPE and have one of the highest risks of transmission due to the close proximity of the healthcare provider to the patient. To reduce the risk of spread and to preserve PPE, we are recommending that all non-essential dental exams and procedures be postponed until further notice.

A tiered framework is provided to inform health systems as they consider resources and how best to provide surgical services and procedures to those whose condition requires emergent or urgent attention to save a life, preserve organ function, and avoid further harms from underlying condition or disease. Decisions remain the responsibility of local healthcare delivery systems, including state and local health officials, and those surgeons who have direct responsibility to their patients. However, in analyzing the risk and benefit of any planned procedure, not only must the clinical situation be evaluated, but resource conservation must also be considered. These recommendations are meant to be refined over the duration of the crisis based on feedback from subject matter experts. At all times, the supply of personal protective equipment (PPE), hospital and intensive care unit beds, and ventilators should be considered, even in areas that are not currently dealing with COVID-19 infections. Therefore, while case-by-case evaluations are made, we suggest that the following factors to be considered as to whether planned surgery should proceed:

  • Current and projected COVID-19 cases in the facility and region.
    • consider the following tiered approach in the table below to curtail elective surgeries. The decisions should be made in consultation with the hospital, surgeon, patient, and other public health professionals.
  • Supply of PPE to the facilities in the system
  • Staffing availability
  • Bed availability, especially intensive care unit (ICU) beds
  • Ventilator availability
  • Health and age of the patient, especially given the risks of concurrent COVID-19 infection during recovery
  • Urgency of the procedure.
Tiers Action Definition Locations Examples
Tier 1a Postpone surgery/ procedure Low acuity surgery/healthy patient– outpatient surgery

Not life-threatening illness

HOPD*

ASC**

Hospital with low/no COVID- 19 census

-Carpal tunnel release

-EGD

-Colonoscopy

-Cataracts

Tier 1b Postpone surgery/

procedure

Low acuity surgery/unhealthy patient HOPD

ASC

Hospital with low/no COVID-

19 census

-Endoscopies
Tier 2a Consider postponing surgery/procedure Intermediate acuity surgery/healthy patient –

Not life threatening but potential for future morbidity and mortality. Requires in-hospital stay

HOPD

ASC Hospital with low/no COVID-19 census

-Low risk cancer

-Non urgent spine & Ortho: Including hip, knee replacement and elective spine surgery

-Stable ureteral colic

-Elective angioplasty

Tier 2b Postpone surgery/procedure if possible Intermediate acuity surgery/unhealthy patient HOPD

ASC
Hospital with low/no COVID-19 census

Tier 3a Do not postpone High acuity surgery/healthy patient Hospital -Most cancers

-Neurosurgery

-Highly symptomatic patients

Tier 3b Do not postpone High acuity surgery/unhealthy patient Hospital -Transplants

-Trauma

-Cardiac w/ symptoms

-Limb threatening vascular surgery

*Hospital Outpatient Department
** Ambulatory Surgery Center
Created by: Sameer Siddiqui MD (used with permission)
Version 3.15.20

© AAAASF, Inc.

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